Eye Twitching | Blepharospasm

Eye twitching is a common condition. People usually notice that one eye feels as if the muscles around the eye involuntary twitch, causing blinking sometimes. In most cases, lack of sleep, too much caffeine intake, or stress can cause this to happen. The medical term for this is orbicularis myokymia. This can be really annoying! Fortunately, it is not associated with long-term problems with your vision or your health. For mild occasional twitching - especially if it is only on one side - we usually recommend trying to decrease caffeine intake, get more sleep, and see if it resolves. In some cases, we can treat this with a low dose of BoTox injections.

Eye Twitching versus Blepharospasm

Some patients have a more serious condition called blepharospasm. Blepharospasm is a condition in which the eyelids spasm, closing involuntarily, forcing the patient to blink excessively. Blepharospasm involves abnormal contractions of the eye muscles and is a form of focal dystonia. Patients with blepharospasm have normal vision, but the disturbance interferes with visual perception and may, in severe cases, result in functional blindness. This means that your eyes see fine when they are open but they are not open long enough for daily functions such as reading or driving.

Dr. Eftekhari is Known for Research on Blepharospasm

Dr. Eftekhari is board-certified and has extensive experience treating blepharospasm both with medical treatment and surgery. He also has published academic research in this area because there is a dire need for better treatments for these patients.

If you are interested in reading a summary of blepharospasm written by Dr. Eftekhari when he was on university faculty at the University of North Carolina at Chapel Hill, please click the link below:

Eyelid Twitching Benign Essential Blepharospasm Review Article

For information about our study on using methylphenidate (Ritalin) to treat blepharospasm, click this link:

Ritalin for Eyelid Twitching Dystonia and Blepharospasm Article

Causes of Blepharospasm

We don't really know what causes the eye twitching in blepharospasm. The way Dr. Eftekhari explains it to patients is that there is a mismatch between your eye and your brain. Normally, your eyelid twitches when its windy, or dust gets into your eye. This is because a signal is sent from the surface of your eye to the deepest part of the brain - called the basal ganglia - and the brain sends a signal back to your eyelids to tell them to blink. This is on purpose! You want eye twitching when there's dust in your eye or it's windy. And you don't want to have to think to do it. It is involuntary and happens by itself.

In patients with blepharospasm, there is a mismatch between the eye and the brain. The eye might perceive some dust or wind, but the signal the brain sends back is way too strong. This faulty circuit leads to excessive eye twitching and blinking. In rare cases, patients cannot open their eyes and their eyelids get stuck. This is known as apraxia of eyelid opening and is a serious manifestation of this condition.

Benign Essential Blepharospasm and Parkinson's Disease

In some cases, there is a genetic component to blepharospasm if there is a family history. Researchers have studied whether blepharospasm means you have Parkinson's disease. They found there is no clear link between benign essential blepharospasm and Parkinson's disease. Sometimes, patient's who already have Parkinson's will also have eyelid twitching. Another way of saying it is: if you have blepharospasm, that does NOT mean you will get Parkinson's disease.

Symptoms of Blepharospasm

Blepharospasm is progressive, usually beginning with excessive eye twitching, blinking and eye irritation. This can happen in the presence of stress factors such as bright lights, fatigue or emotional distress. Almost always present in both eyes, as the condition progresses symptoms occur more and more frequently, interfering with daily activities. Symptoms of blepharospasm do not occur during sleep and patients may experience a period of relief from symptoms upon waking. When the disorder becomes extreme, patients may be unable to open their eyes for hours at a time.

As times blepharospasm may occur with twitching affecting the mouth and jaw. This is known as oromandibular dystonia. In oromandibular dystonia, the patient involuntarily grimaces, clenches the jaw muscles and sticks out the tongue. When blepharospasm and oromandibular dystonia occur concurrently we call it Meige syndrome. Patients with blepharospasm may experience continuing sensitivity to bright light and dry eyes.

Diagnosis of Blepharospasm

At present, there is no specific test for blepharospasm and, in most cases, laboratory results in patients with the disorder are normal. Blepharospasm is typically diagnosed on the basis of:

  • Patient history
  • Physical examination
  • Neurological evaluation

Medical diagnosis is necessary to distinguish blepharospasm from other conditions affecting the eyelids, such as infection, allergy, and other conditions resulting in muscular weakness or contractions.

Treatment of Blepharospasm

Eye twitching in the setting of blepharospasm can be very debilitating for patients. Fortunately, in the early 1980s ophthalmologists in San Francisco discovered a medicine that can temporarily weaken muscles that causes these spasms. This medicine is a toxin known as botulinum toxin or "botox." BoTox is a now a brand-name medication and there are other formulations like Xeomin and Dysport. All have been shown in studies to improve the spasms in blepharospasm. Insurance provides medical coverage to get these injections for spasms. Dr. Eftekhari has performed thousands of BoTox injections in his career and has extensive experience using it to treat blepharospasm. Most patients receive injections every 3 months.

For patients who don't respond fully to BoTox, sometimes we prescribe medical treatments including methylphenidate (Ritalin) or benzodiazepines (Valium).

Some patients have a severe form of the spasms called apraxia of eyelid opening. Dr. Eftekhari trained with the world's foremost expert in this entity, Dr. Richard Anderson, who developed a surgery called the myectomy surgery. In this surgery, Dr. Eftekhari carefully removes every visible fiber of the upper eyelid muscle that squeezes the eye shut in order to treat the severe spasms. Dr. Eftekhari is one of only a select few doctors in the world trained to perform the orbicularis oculi myectomy surgery and has performed many of these surgeries in his career.

If you have eye twitching or spasms, please call our office for an evaluation with Dr. Eftekhari.

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